Accommodating Children With Special Dietary Needs Table Of .
Accommodating Children With Special DietaryNeeds—Table of ContentsSpecial Dietary NeedsDefinitions of Disability and of Other Special Dietary NeedsIndividuals With Disabilities Education ActPhysician’s Statement for Children With DisabilitiesIn Cases of Food AllergyOther Special Dietary NeedsLactose IntoleranceFluid Milk SubstitutionsSchool IssuesSchool Nutrition Program (SNP) Department ResponsibilitiesProviding Special Meals to Children With DisabilitiesMenu Modifications for Children With DisabilitiesTexture Modifications for Children With DisabilitiesServing the Special Dietary Needs of Children Without DisabilitiesFunding SourcesPrice of MealsIncurring Additional ExpensesLegal Concerns and Liability in Working With ChildrenWith DisabilitiesSchool Responsibility to Make AccommodationsTitle II Americans With Disabilities ActPersonal Responsibility in Cases of NegligenceAdministering FeedingsDiet OrdersNegligenceSituations and ResponsesMeals and/or Foods Outside of the Normal Meal ServiceSpecial Needs Which May or May Not Involve DisabilitiesResponsibilities of Food Service Management Companies (FSMC)and Other Child Nutrition OperationsFeeding in Separate Facilities — Generally Not AcceptableTemporary DisabilitiesComplicated FeedingsSchool Nutrition Program AccountDocumentationTexas Department of Agriculture — November modating Children withSpecial Dietary Needs 13.a
Allowing Variations for Religious ReasonsJewish Schools and RCCIsSeventh Day Adventist Schools and RCCIsSample Documentation for Special Dietary NeedsEating/Feeding EvaluationInformation CardEating and Feeding Evaluation: Children with SpecialDietary NeedsInformation CardGlossaryAmericans With Disabilities Act (ADA)Anaphylaxis/Anaphylactic ReactionDisabilityFood AllergyFood IntoleranceFree Appropriate Public Education (FAPE)Individuals With Disabilities Education Act (IDEA)Individualized Education Program (IEP)Licensed Dietitian (L.D.)Osteopathic Physician or Doctor of Osteopathic MedicineRecognized Medical AuthorityRegistered Dietitian (R.D)Rehabilitation Act of 1973Special Dietary NeedsAccommodating Children withSpecial Dietary Needs 13.b13.2413.3313.3413.3513.36Texas Department of Agriculture — November 2011
AccommodatingChildren With SpecialDietary NeedsSpecial Dietary NeedsIn recent years, we have seen increasing emphasis on the importance of ensuring children withdisabilities have the same opportunities as other children to receive an education andeducation-related benefits, such as school meals.Congress first addressed this concern in The Rehabilitation Act of 1973, which prohibitsdiscrimination against qualified persons with disabilities in the programs or activities of anyagency of the federal government’s executive branch or any organization receiving federalfinancial assistance.Subsequently, Congress passed the Education of the Handicapped Act (now, the Individualswith Disabilities Education Act), which requires a free and appropriate public education beprovided for children (ages 3 through 21) with disabilities, and the Americans with DisabilitiesAct, a comprehensive law that broadens and extends civil rights protections for Americans withdisabilities.One effect of these laws has been an increase in the number of children with disabilities who arebeing educated in regular school programs. In some cases, the disability may prevent the childfrom eating meals prepared for the general school population.The U.S. Department of Agriculture’s (USDA) nondiscrimination regulation, as well as theregulations governing the National School Lunch Program (NSLP) and School BreakfastProgram (SBP), make it clear that substitutions to the regular meal must be made for childrenwho are unable to eat school meals because of their disabilities when that need is certified by alicensed physician.In most cases, children with disabilities can be accommodated with little extra expense orinvolvement. The nature of the child’s disability, the reason the disability prevents the child fromeating the regular school meal and the specific substitutions needed must be specified in astatement signed by a licensed physician.Texas Department of Agriculture — November 2011Accommodating Children withSpecial Dietary Needs 13.1
Often, the substitutions can be made relatively easily. There are situations, however, which mayrequire additional equipment or specific technical training and expertise. When these instancesoccur, it is important that food service staff and parent(s) be involved at the outset inpreparations for the child’s entrance into the school.USDA has developed a guidance to describe some of the factors that must be considered in theearly phases of planning and suggests ways in which School Nutrition Program (SNP)department staff can interact with other responsible parties in the school and the community atlarge to serve children with disabilities. This guidance, Accommodating Children with SpecialDietary Needs can be found on the USDA Food and Nutrition Service (FNS) website m. The guidance is based on the USDA policy,Meal Substitutions for Medical or Other Special Dietary Reasons.Serving children with disabilities presents child nutrition department staff with new challengesas well as rewards. This guidance presents information on how to handle situations that mayarise and offers advice about such issues as funding and liability.Definitions of Disability and of Other Special Dietary NeedsUnder Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act(ADA) of 1990, a “person with a disability” is any person who has a physical or mentalimpairment that substantially limits one or more major life activities, has a record of such animpairment or is regarded as having such an impairment.The term “physical or mental impairment” includes many diseases and conditions, a few ofwhich may be orthopedic, visual, speech and hearing impairments; cerebral palsy; epilepsy;muscular dystrophy; multiple sclerosis; cancer; heart disease; metabolic diseases, such asdiabetes or phenylketonuria (PKU); food anaphylaxis (severe food allergy); mental retardation;emotional illness; drug addiction and alcoholism; specific learning disabilities; HIV disease andtuberculosis.Major life activities covered by this definition include caring for one’s self, eating, performingmanual tasks, walking, seeing, hearing, speaking, breathing, learning and working.Individuals with Disabilities Education ActThe Individuals with Disabilities Education Act (IDEA) is a federal law that requires each state toensure that a free appropriate public education (FAPE) is available to all eligible children withdisabilities residing in that state. IDEA is designed to improve educational results for all childrenwith disabilities. The Provisions Related to Children with Disabilities Enrolled by Their Parents inPrivate Schools section of IDEA establishes that the private school is obligated to locate, identify,evaluate and spend a proportionate share of IDEA funds for equitable services for children withdisabilities enrolled by their parents in private, including religious, elementary and secondaryAccommodating Children withSpecial Dietary Needs 13.2Texas Department of Agriculture — November 2011
schools within the contracting entity (CE). IDEA defines a child with a “disability” as one who isevaluated in accordance with IDEA as having one or more of the recognized 13 disabilitycategories and who, by reason thereof, needs special education and related services.IDEA recognizes the following disability categories that establish a child’s need for specialeducation and related services. These disabilities include: autism; deaf-blindness; deafness orother hearing impairments; mental retardation; orthopedic impairments; other healthimpairments due to chronic or acute health problems, such as asthma, diabetes, nephritis, sicklecell anemia, a heart condition, epilepsy, rheumatic fever, hemophilia, leukemia, lead poisoning,tuberculosis; emotional disturbance; specific learning disabilities; speech or languageimpairment; traumatic brain injury; and visual impairment, including blindness whichadversely affects a child’s educational performance; and multiple disabilities.Attention deficit disorder or attention deficit hyperactivity disorder may fall under one of theabove categories. Classification depends upon the particular characteristics associated with thedisorder and how the condition manifests itself in the student, which will determine thecategory.The Individualized Education Program (IEP) is a written statement for a child with a disabilitythat is developed, reviewed and revised in accordance with the IDEA and its implementingregulations. The IEP is the cornerstone of the student’s educational program that contains theprogram of special education and related services to be provided to a child with a disabilitycovered under the IDEA.Some states supplement the IEP with a written statement specifically designed to address astudent’s nutritional needs. Other states employ a “Health Care Plan” to address the nutritionalneeds of their students. For ease of reference, the term “IEP” is used to reflect the IEP as well asany written statement designating the required nutrition services.When nutrition services are required under a child’s IEP, school officials must ensure that childnutrition department staff are involved early in decisions regarding special meals.Physician’s Statement for Children with DisabilitiesUSDA regulations require substitutions or modifications in school meals for children whosedisabilities restrict their diets. A child with a disability must be provided substitutions in foodswhen that need is supported by a statement signed by a licensed physician.The physician’s statement must identify:The child’s disability;An explanation of why the disability restricts the child’s diet;The major life activity affected by the disability;The food or foods to be omitted from the child’s diet and the food or choice of foods thatmust be substituted.Texas Department of Agriculture — November 2011Accommodating Children withSpecial Dietary Needs 13.3
In Cases of Food AllergyGenerally, children with food allergies or intolerances do not have a disability as defined undereither Section 504 of the Rehabilitation Act or Part B of IDEA. The SNP department may, but isnot required to, make food substitutions for them.However, when in the licensed physician’s assessment food allergies may result in severe,life-threatening (anaphylactic) reactions, the child’s condition would meet the definition of“disability,” and the substitutions prescribed by the licensed physician must be made.Other Special Dietary NeedsThe SNP department may make food substitutions, at their discretion, for individual studentswho do not have a disability but who are medically certified as having a special medical ordietary need.Such determinations are only made on a case-by-case basis. This provision covers those studentswho have food intolerances or allergies but do not have life-threatening reactions (anaphylacticreactions) when exposed to the food(s) to which they have problems.For students with special dietary needs, schools must:Provide substitutions on a case-by-case basis;Maintain the required medical statement in their files;Provide the meal or substitution at no additional cost to the child; andDocument substitutions made to meals.Lactose Intolerance“Lactose intolerance” describes a difficulty digesting the sugar found in milk and milk foods.Symptoms associated with lactose intolerance may be reduced or eliminated if:Small, frequent portions of milk are consumed rather than large portions;Milk or milk foods are consumed with other foods; orWhole or chocolate milk, yogurt with active cultures, ice cream and aged hard cheeses likecheddar and Swiss are consumed.If a student requires lactose-reduced milk, the school may provide lactose-reduced/lactose-freemilk as a creditable part of a reimbursable meal without additional documentation. If the schoolserves a meal without milk to a student, they cannot claim reimbursement.Accommodating Children withSpecial Dietary Needs 13.4Texas Department of Agriculture — November 2011
Fluid Milk Substitutions in the Child Nutrition ProgramsThe final rule, Fluid Milk Substitutions in the School Nutrition Programs was published onSeptember 12, 2008. This rule addresses the substitutions of fluid milk for students whosenon-disabling allergies, culture, religion or ethical beliefs preclude the consumption of cow’smilk. The final rule sets nutrition standards for the nondairy milk substitutes that may be offeredas part of the reimbursable meal.Schools may make substitutions for fluid milk for non-disabled students who cannot drink fluidmilk due to medical or special dietary need. Medical or special dietary need may include, but isnot limited to, lactose intolerance, dairy allergies and/or cultural dietary restrictions. This fluidmilk substitution may be offered to all students as a milk choice as long as the milk substitution:is an approved fluid milk substitute (see the current list of approved milk substitutes below);is part of a reimbursable meal; andstudents do not have to pay extra for the milk substitute.Current approved milk substitutes:Pacific Natural Foods – Ultra Soy PlainPacific Natural Foods – Ultra Soy VanillaStremicks Heritage Foods – 8th Continent Soymilk OriginalKikkoman – Pearl Soy, all flavorsSunrich Naturals – Original and VanillaNote: Any expenses incurred when providing substitutions for fluid milk that exceeds NSLPand SBP reimbursement must be paid by the CE.The CE must inform TDA if any of its schools choose to offer fluid milk substitutions fornon-disabled students. CEs must submit written notification to TDA on CE letterhead via postalservice, fax or email of their decision to offer a fluid milk substitution prior to the purchase of thefluid milk substitute.If the school chooses to provide a substitution to fluid milk for non-disabled students, the offermust remain in effect until the school changes its fluid milk substitution policy for non-disabledstudents (i.e., school chooses to no longer provide fluid milk substitutions for non-disabledstudents).Fat content of fluid milk substitutions, such as soy milk are not subject to the regulationsregarding fat content that apply to regular fluid milk. Therefore, fluid milk substitutions canhave a higher fat content than fat free or 1%.The nutrients found in milk are very important to the development and growth of students. Aschool that chooses to provide substitutions for fluid milk must ensure that the substitutionmeets specific nutritional standards (unless otherwise stated in an authorized medicalTexas Department of Agriculture — November 2011Accommodating Children withSpecial Dietary Needs 13.5
authority’s written substitution). The non-dairy beverages must provide the nutrients listed inthe table below.NutrientCalciumProteinVitamin AVitamin DMagnesiumPhosphorusPotassiumRiboflavinVitamin B-12Per Cup276 mg8g500 IU100IU24 mg222 mg349 mg0.44 mg1.1 mcgNote: Schools can still offer lactose-free milk to a student with a medical or special dietary need,such as lactose intolerance. Lactose-free milk is still allowed as part of a reimbursable meal.Note: If schools do not offer versus serve, they can serve both milk and water, however theschool can only claim meals served with milk or a fluid milk substitute meeting the requirementsof this section for reimbursement.Refer to the questions and answers below for additional information.1. Question: What are the main changes prompted by the final rule?Answer: The most significant changes made by the final rule are:Allows parents/guardians to request a fluid milk substitute for a student with medical orspecial dietary needs other than a disability; andEstablishes nutrient standards for nondairy beverages offered as fluid milk substitutes inthe School Nutrition Programs.2. Question: Does the final fluid milk substitution rule apply to the NSLP, SBP, ASCP and theSSO?Answer: Yes, the milk substitution provision is applicable to all institutions participating inthe NSLP, SBP, ASCP and the SSO. If a school or institution chooses to offer a milk substitutefor a student with a medical or special dietary need other than a disability, the nondairyproduct that is offered as part of the reimbursable meal must meet the nutrient standardsestablished by the final rule.3. Question: Is a meal without fluid milk or an acceptable milk substitute reimbursable?Accommodating Children withSpecial Dietary Needs 13.6Texas Department of Agriculture — November 2011
Answer: Under Offer vs. Serve, a meal without fluid milk is reimbursable. If there is no Offervs. Serve, a reimbursable meal must include milk or an acceptable milk substitute asdescribed in the final rule, except for a student with a disability (in which case the rule doesnot apply because the school must follow the licensed physician’s written statement).4. Question: Must the school offer a milk substitute for a student with a medical or specialdietary need at the request of a medical authority or a parent?Answer: No, a school has the discretion to offer a milk substitute as part of the reimbursablemeal to a student with a medical or special dietary need other than a disability. However,there is concern about the ability of children making this request to obtain the key nutrientsfound in fluid milk through the SNP. TDA encourages schools to try to meet the dietaryneeds of these students by offering a nondairy beverage that meets the nutritionrequirements of milk substitutes noted above. If the school chooses to do so, it must accept awritten request from a medical authority or a parent/legal guardian.5. Question: Must a school comply with a statement from a licensed physician or a medicalauthority indicating that a specific beverage (e.g., juice) must be provided in place of milk to astudent with a medical or special dietary need other than a disability?Answer: No, a school needs to comply with a statement from a licensed physician only whena milk substitution is necessary due to a disability. When the milk substitution request is dueto a medical or special dietary need other than a disability, the school may choose whether toaccommodate the student and provide the nondairy beverage(s).6. Question: If a school chooses to offer milk substitutes for children with medical or specialdietary needs, may it only accept written requests from medical authorities?Answer: No, the school does not have the option to refuse a parent’s request. Regulationsallow a statement from the parent/guardian, as well as a medical authority.7. Question: What type of documentation must be submitted to the school to request a milksubstitute for a student with a medical or special dietary need other than a disability?Answer: The written request from the medical authority or the parent/guardian mustidentify the student’s medical or other special dietary need that precludes the consumptionof cow’s milk. No other information is required.8. Question: Do the regulations prohibit a school food service operation from offering studentswith medical or special dietary needs a milk substitute that does not meet the nutrientstandards in the Final Rule?Texas Department of Agriculture — November 2011Accommodating Children withSpecial Dietary Needs 13.7
Answer: The final milk substitution rule addresses the substitution of milk as part of thereimbursable school meal. However, if a meal includes a milk substitute that does not meetthe requirements of the rule (e.g., juice) no reimbursement would be provided for that meal.9. Question: Is it necessary to offer a choice of acceptable milk substitutes?Answer: No, a school may offer one or more acceptable milk substitute
Texas Department of Agriculture — November 2011 Accommodating Children with Special Dietary Needs 13.a Accommodating Children With Special Dietary Needs—Table of Contents Special Dietary Needs 13.1 Definitions of Disability and of Other Special Dietary Needs 13.2 Individuals With Disabilities Education Act 13.2 Physician’s Statement for Children With Disabilities
Special Dietary Needs May 2013 Accommodating Children with Special Dietary Needs in the School Nutrition Programs Accommodating Students with Disabling Special Dietary Needs Schools participating in a federal Child Nutrition Program (School Lunch, School Breakfast or After School
Accommodating Special Diets Connecticut State Department of Education December 2020 v About This Guide The Connecticut State Department of Education’s (CSDE) guide, Accommodating Special Diets in School Nutrition Programs, contains information and guidance on the requirements for modifying meals for children with special dietary needs in the U.S. Department of
GUIDANCE FOR ACCOMMODATING CHILDREN WITH SPECIAL DIETARY NEEDS IN THE SCHOOL NUTRITION PROGRAMS I. INTRODUCTION In recent years, we have seen increasing emphasis on the importance of ensuring that children with disabilities have the same opportunities as other children to receive an education and education-related benefits, such as school meals.
Dietary Guidelines Advisory Committee. 2010. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture
U.S. Dietary Guidelines Low Awareness Barriers to Adoption and Use High Skepticism About 50 % of Americans are aware of the Dietary Guidelines*; just 1 in 10 know what they say* 33% call the Dietary Guidelines ―complicated‖* Just 18% say the Dietary Guidelines influen
(HHS/USDA) 2005 Dietary Guidelines for Americans Dietary Guidelines for Americans (USDA/HHS) 2010 McGovern Report - Dietary Goals (6) 1977 Surgeon General's Report on Health Promotion 1979 Dietary Guidelines for Americans (USDA/HH
Background: Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The
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